The protagonist of The Lost and Damned is Johnny Klebitz, Vice-President of the Alderney chapter of The Lost MC, a motorcycle club which, along with himself, featured in a number of missions throughout the course of Grand Theft Auto IV. The main storyline of the episode focuses on Johnny's efforts to keep the chapter running, while dealing with internal conflicts, gang warfare, drug running, and various enemies. The storyline shows Johnny's perspective in regard to the infamous diamond deal of Grand Theft Auto IV.

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Grand Theft Auto IV: The Lost and Damned is an action-adventure game set in an open world environment and played from a third-person perspective. It features similar gameplay to that of Grand Theft Auto IV, and takes place in the same setting of Liberty City, the game only features around a third of the number of missions from that game, as was stated in an interview between IGN and the president of Rockstar North, which thus places the amount of time to complete it at approximately 10–15 hours, depending on how focused the player is on the storyline.[5] The game also features new additions, some in regard to Johnny's connection to the Lost MC, and some minor changes.

The most prominent of these additions is the availability of mid-mission checkpoints, which can spare the player repeated trips to a given location in order to trigger and replay a failed mission again — an often criticised aspect of the Grand Theft Auto series. Checkpoints are only available by retrying the mission after it has been previously failed — going to the mission start point begins the mission from scratch. Alongside the Checkpoint system, The Lost and Damned features the inclusion of new weapons and vehicles, including Johnny's custom-made motorcycle (Johnny himself is more proficient with any bike than with any other vehicle), the ability to call on aid from members of the Lost MC, a new but small collection of random characters, additional side activities, and unique side jobs including Gang Wars and Bike Races. In addition, the game has a few changes to that of Grand Theft Auto IV, in that Johnny can access the whole of Liberty City from the start of a new game, but cannot change his clothing or enter clothing stores. The city's comedy club, Split Sides, also features a brand new comedian doing routines there, while gun stores do not stock any of the new weapons featured in The Lost and Damned; they can only be bought through the club's gun vendor.

Two of the new side jobs featured in The Lost and Damned - Gang Wars and Bike Races - require Johnny to be on a bike to trigger them. In Gang Wars, Johnny battles against rival gangs in a few variations - taking them out at a hangout, or while cruising the streets, or destroying a vehicle they are escorting - earning money from each war completed and unlocking a weapon at the Lost clubhouse (and a safehouse acquired later in the story) with every 10 subsequent Wars completed. Each gang war becomes tougher, the more Johnny continues engaging in them. Meanwhile, Bike Races play out like the Street Races of Grand Theft Auto IV, except both Johnny and his opponents carry a baseball bat to attack their rival racers while making their way to each checkpoint of the race, with each capable of dislodging a racer from their bike depending on the strength of their swing. Other side jobs see Johnny either stealing bikes or working for a congressman met during the game's story. Meanwhile, the new additions to the activities from Grand Theft Auto IV, include Arm Wrestling (which differs in difficulties and wagers between various spots), games of Hi-Lo cards, and Air Hockey (found at the city's Bowling Alleys). The new weapons featured in the game includes the sawn-off shotgun, assault shotgun, pool cues, grenade launchers and pipe bombs.

Because of Johnny's position in the Lost MC, some missions and Gang Wars can see him accompanied by a team of bikers who, if they survive through either, can improve and gain experience and thus become more battle-hardened in later missions/Gang Wars. If, at any time, a biker is killed in a mission or gang war, they will be replaced by another in the next. Johnny can receive further support from two members of the Lost - Terry and Clay; both can be taken out for friend activities, but have their special abilities active from the beginning of a new game. If Terry is called, he will drive to a location near to Johnny and sell him weapons and armour, while Clay can deliver a bike of the player's choice to him directly. At a later stage in the game, Johnny can call one or the other, while on a mission, to gain back-up from them, with both capable of gaining experience that increases their health, combat abilities, and grant them better weapons.

While the single player has new additions, multiplayer is also given new modes, connected to the Lost MC, some of which improve on those featured in Grand Theft Auto IV:

Witness Protection - One team is The Lost biker gang and they must try to eliminate a bus carrying witnesses while the other team is NOOSE who try to protect the bus as it delivers the witnesses to police stations around Liberty City.

Races - Racing on bikes with racers carrying bats and smashing each other, similar to the video game Road Rash.

Lone Wolf Biker - Free for all style mode where one player is the Lone Wolf and all other players must chase and kill that player to become the Lone Wolf. At the end of the game, whoever was the Lone Wolf for the longest time, wins.

Own the City - Try to gain control of the city section by section, based on San Andreas' gang wars.

Club Business - Like the original Mafia mode in GTA IV, but with a total of 8 players riding together as one gang. The player receives calls from Angus who tells you to carry out certain tasks for The Lost.

Chopper vs. Chopper - Helicopter vs bike. Bike rider tries to get through checkpoints while the helicopter tries to stop the biker.

Much of The Lost and Damned takes place at the same time as the events of Grand Theft Auto IV and those of The Ballad of Gay Tony, with the game's missions intertwining with those of both games, allowing players to see these events from Johnny's perspective.

Billy Grey, club president of the Lost MC in Alderney, is finally released from a court-ordered rehab after being arrested for narcotics possession. His vice-president, Jonathan "Johnny" Klebitz, is not happy about his return, after having spent the past year as the club's acting president all while dealing with its debt, mainly from Billy's leadership, and having a truce with the Lost's rivals, The Angels of Death, in order for the Lost to run their drug and gun running operations more freely throughout Liberty City. Following his release, Billy quickly breaks the truce with the Angels before instigating a war with them, causing tensions between him and Johnny to grow, with the latter more interested in keeping the club's business running smoothly than engaging in fights with the Angels.

Shortly after hearing news that the Lost MC's Enforcer, Jason Michaels, was killed in Broker, Billy prompts an attack on an Angels' clubhouse. Despite assisting in the attack, Johnny is uncertain about his claim that the Angels killed Jason, which is further strengthened when he watches Billy and the club's secretary, Brian Jeremy, remove a stash of heroin after the attack. Despite the uncertainty, Johnny is soon forced by Billy to meet with drug lord Elizabeta Torres, who helps to find a buyer for the drugs. However, the deal goes wrong, despite assistance from Niko Bellic (the main protagonist of Grand Theft Auto IV, and the one who actually killed Jason), before matters are made worse when Jim Fitzgerald, the club's treasurer and Johnny's best friend, reveals that the heroin they stole actually belonged to the Triads. Persuading Billy that they must return it to them, he and Jim are made to hand it back themselves, but quickly come under fire as the Triads retaliate against them for the theft of their heroin. While the pair survive, the gunfight prompts the arrival of the police, who arrest Billy for the incident, while the pair watch.

Prompted to become the Lost's president, Johnny attempts to keep the Lost MC stable, by taking on work with Elizabeta, Jim and Uptown Riders, Malc and DeSean. He also becomes entrapped by congressman Thomas Stubbs III, into working for him in dealing with several problems, while also having to help his ex-girlfriend, Ashley, with a few problems connected to her drug habit, which include resolving her debt to Russian mobster Dimitri Rascalov by having to kidnap Roman Bellic. At the same time, Brian, who is still faithful to Billy and believes Johnny to be responsible for Billy's arrest, starts a civil war against him, which soon culminates in an ambush after he tries to deceive him into believing that he wants to arrange a truce with him. While the ambush leads to most of the Alderney chapter dying, Johnny and his friends survive, whilst Brian escapes and goes into hiding.

Eventually, Johnny tracks down Brian and forces him to end his conflict with them, after Ray Boccino, a Mafia capo, sells his location to him in the interest of establishing his business with the Lost. After dealing with Brian, Johnny repays Boccino for his info by helping him steal $2 million worth of diamonds being bought by Anthony "Gay Tony" Prince, during which he also kills Tony's boyfriend, Evan Moss. Shortly after leaving the diamonds to be collected by Boccino's men, Johnny is called to oversee the deal in the Libertonian Museum alongside Niko, in order to collect his share of the $2 million from the diamonds. While the deal goes badly wrong, Johnny manages to steal all of the money and escapes with it, only for a suspicious Boccino to capture him and Jim to get it back. Although the pair manage to escape their captivity and Johnny ambushes Boccino's hitmen, his return to the clubhouse is met with news from Ashley that Jim was killed (secretly by Niko) shortly after they parted ways.

A short while later, with the Alderney chapter virtually coming apart, Stubbs meets with Johnny and explains that Ray is under observation by the FIB and that he should stay away from him. Stubbs then reveals that Billy is planning to testify against the Lost, pinning all its crimes on Johnny while he enters the Witness Protection Program. Johnny, seeking to kill him for his treachery, leads the remaining members of the Lost in a daring raid on the Alderney State Correctional Facility, where Billy is being detained, and executes him. With Billy dead, the surviving members of the Lost - Clay Simons, Terry Thorpe and Angus Martin - return to their clubhouse, only to find it vandalised by Boccino's men. Knowing that their brotherhood in Alderney is truly destroyed, the group decide to "put the clubhouse out of its misery", and set fire to it, watching it burn. After the closing credits, Johnny calls Stubbs to inform him about Billy's death before parting ways with him after a final and friendly conversation with him. He then receives a phone call from Ashley, who tries to get money from him, only for Johnny to finally end his ties to her, before he subsequently calls Angus to state his intention of severing ties with the Lost and supporting Jim's widow and child for the time being.

The content was first announced during Microsoft's 2006 E3 press conference on 9 May 2006.[6]Peter Moore, then head of Microsoft's Interactive Entertainment Business division, described downloadable content as "epic episode packs", and not just an extra car or character. A press release during the conference said that the expansion packs, both The Lost and Damned and The Ballad of Gay Tony would add "hours of entirely new gameplay" to the game,[7] with Jeronimo Barrera, Vice-President of Product Development for Rockstar Games, explaining that the episodes were experiments because they were not sure that there were enough users with access to online content on the Xbox 360.[8] Take-Two Interactive's Chief Financial Officer, Lainie Goldstein revealed that Microsoft was paying a total of $50 million for the first two episodes.[9]

On 20 February 2008, it was initially announced that the extra content would be introduced starting August 2008.[10] Dan Houser, vice-president of creative development at Rockstar Games, claimed that through this episode, it would show "a different side of Liberty City".[11] As part of its second quarter financial reports Take-Two announced that the downloadable content had been delayed and would be released during the first quarter of its 2009 financial year (November 2008–January 2009).[12] On 13 November 2008, Take-Two executive chairman Strauss Zelnick warned that while they were aiming to release the first episode pack by January 2009, the date may have had to change to the second financial quarter of 2009 (February–April) depending on the completion date.[13][14] 17 February's release date was eventually announced one week after Zelnick's warning.[15]

Grand Theft Auto IV: The Lost and Damned received "generally favorable" reviews from critics, according to review aggregatorMetacritic.

Critics cited its improved motorcycle mechanics in comparison to the previous games, dramatic storyline, quality voice acting, addictive multiplayer component and other new content which added many hours of game time. Complaints with the game have included auto-aiming issues and weak gang AI, which were a noticeable problem in the original game.

In the opening cutscene for the mission 'Politics', Tom Stubbs exposes his genitals in a full-frontal shot facing towards the camera after getting off a massage table and discussing his plans with Johnny. Parental advisory group Common Sense Media issued a public warning about the expansion pack due to a full-frontal male nudity scene during the cutscene. They claimed the game was "even more controversial than its predecessors" because it featured "full frontal male nudity".[22]